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WAL-MART PHARMACY 10-3731
DSH320089 UNM SANDOVAL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
UNM SANDOVAL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320089
Entity Address
3001 BROADMOOR BLVD NE
RIO RANCHO, NM 87144
Medicare Provider Number
320089
Participating Start Date
4/1/2016
Last Recertification Date
8/17/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3731
Pharmacy Address
460 NM HIGHWAY #528
BERNALILLO, NM 87004
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jamie Silva-Steele, President and CEO
(505) 994-7430
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2021
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